STEADI Cuts Repeat Hospitalizations for Fall Injuries 60%

Every second of every day, an American age 65+ falls. Every 20 minutes, an older American dies from a fall. Surveys show that 28.7% of Americans age 65+ fall each year, and the prevalence continues to rise with age.¹ Treatment of these injuries costs Medicare $31.3 billion annually.² That cost is likely to rise as America’s senior population expands 55% by the year 2030. A clear way for primary care practitioners to protect patients from this injury, loss of independence, and death is to identify patients at risk of falls and reduce those risks. Government agencies such as CMS and the CDC are hoping these practices can also curb national spending on the leading cause of fatal and non-fatal injuries among seniors. Multifactorial approaches in primary care have been shown to reduce falls by 24%.³

To facilitate an evidence-based, thorough approach to reducing fall risk, the CDC developed for primary care a package of guidelines and resources called the STEADI initiative (Stopping Elderly Accidents, Deaths, and Injuries): www.cdc.gov/steadi/. Although the resources were developed for primary care, the methods were recently adopted and studied by the Rees-Jones Trauma Center.⁴ In their two-year trial, they applied STEADI to 2,784 patients admitted to the trauma center. The STEADI process is largely an organized, efficient approach to multifactorial risk assessment and reduction. Three yes-or-no questions are used to screen all incoming patients. Patients with a yes answer then receive assessments for modifiable factors such as strength, gait, posture, vision, and balance. Referrals are made for physical therapy, occupational therapy, optometry, home safety inspection, etc. as needed. The Rees-Jones center used the Beers Criteria in medication review to identify medications that may be harmful or inappropriate for older adults. Finally, all patients with fall risk were prescribed 800 IU of vitamin D supplements daily. Before implementing STEADI, patients admitted with fall injuries had an average length of stay of 7.9 days with 46.8% of patients discharged to home. After implementing STEADI, hospital length of stay for fall injuries decreased to five days with 63.6% of patients being discharged to the home. STEADI was associated with a 37% reduction in inpatient length of stay, a 36% increase in the percentage of patients who could be discharged to home, and a 60% decrease in the percentage of patients readmitted for repeat falls.

STEADI starts with three simple questions to be asked at the first senior exam and annually: (1) Have you fallen in the past year? (2) Do you feel unsteady when standing or walking? (3) Do you worry about falling? A yes answer to any of these prompts a more thorough exam encompassing physical ability, vision, medication review, and vitamin D. For your homebound patients, make Five Star Home Health your ally in taking a stand against falls. With Medicare paying 100%, Five Star Home Health can perform an in-home medicine cabinet review, home safety evaluation, and a thorough physical therapy assessment. We can then report back to you, summarizing the results of each assessment, and suggesting orders and a plan of care for using home health to provide fall injury prevention rehab. 

Achieving Medicare’s 4-Star Rating

Founded in 2003, this agency was named Five Star long before Medicare provided star ratings to home health agencies, so it is only fitting that we have earned Medicare’s coveted 4-Star rating. This puts Five Star in the top 24% of home health agencies. Medicare bases quality ratings on risk-adjusted, objective measures. For instance, compared to other home health agencies, the patients you refer to Five Star prove 10% more likely to improve with ambulation and 38% less likely to visit the ER.

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References:

1. Bergen G, Stevens MR, Burns ER. Falls and Fall Injuries Among Adults Aged ≥65. MMWR Morb Mortal Wkly Rep. 2016; 65: 993–998.
2. Burns E, Stevens J, Lee R. The direct costs of fatal and non-fatal falls among older adults – United States. J Safety Res. 2016; 58: 99-103.
3. Gillespie L, Robertson M, Gillespie W, et al. Interventions foor preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012; (9): CD007146.
4. Centers for Disease Control and Prevention, National Center for Injury Prevention and Control, Division of Unintentional Injury Prevention. Keep them STEADI: preventing older adult falls in hospital-based settings. Sept 2016. Available at: cdc.gov/steadi/stories/hospital.html.